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Boundaries in Church Therapy

Many people ask me, “How does it work for the professional therapist to see clients at his or her own church? Doesn’t that violate counseling boundaries?” This is a great question that is worthy of attention. Clearly professional counselors are bound by ethical codes, such as the one created by the American Counseling Association. Boundaries must be in place to protect the therapeutic relationship, the client, and the counselor.

Licensed therapists practice in a variety of settings, such as hospitals with a group milieu and agencies that offer wraparound services (multiple providers offering different aspects of treatment all around a common goal). Those in private practice typically only see the client in the office and do not interact with clients outside the office. For the private practice setting this is absolutely essential for both the client and the counselor as this is the agreed-upon context in which the work can take place.

Church therapists are professionals working on a church staff. You are a part of the church’s leadership team, offering insights and education to pastors as well as providing care in the context of the church. Your office is in the church building. When thinking about appropriate boundaries, it is critical to first look at the context of treatment. Where and how have both you as the counselor and your client agreed upon for treatment to take place? In church therapy, both the counselor and the client have entered into treatment with the understanding that work will take place in the church building, that the pastors are a part of the treatment team (be sure to have the client sign releases for any pastor or other provider to whom you may speak), and that the counselor will be present in other areas of the church building at other times when therapy is not in session.

Now we enter the more complicated realm: when the church therapist and client see each other in the church setting but OUTSIDE the therapy office, how do they interact? I personally begin treatment with the client by talking about this before we begin any work. I assure them that I will never ask them follow-up questions or get therapy updates outside of the therapy office. I ask the client to use my voicemail to reschedule appointments rather than approaching me in church. Once I was even asked if I would ever share a prayer request about one of my clients… (That would be a big NO!). My clients and I may wave or say hi in the church building, just as I would with anyone else. The goal here is to make your interaction with clients at church mirror your interaction with anyone else. Remember, even the fact that a client is coming to see you must remain confidential along with the content of the therapy itself. Only those for whom the client has signed a release form can know that he or she is in treatment with you. To be a successful church therapist, you MUST be on guard to keep very tight lips.

Because the church therapist is on church staff in the role of professional therapist, anytime he or she is in the church building he or she is in that role. Those in private practice or agency work have the right to expect that their church experience will be their own and will not become complicated with client interactions. Their place of work is outside of the church setting, and as a result their client interactions are all separate from their church lives. However, the church therapist is one who has felt a calling to church leadership AND to counseling. Therefore, your expectation is to be “on” when you are at church. This is more similar to the role of pastor in the sense that your social/spiritual life is supplementally fed outside of your church.

It is critical for the church therapist to realize that he or she cannot develop many intimate friendships at church. I personally have a small handful of confidants, 2-3 of whom attend my church and 2-3 of whom do not. Those I trust who do attend my church never ask about my work and I never discuss it with them. We also have a clear understanding that (much like the pastor) when we are at church I am in the role of on-staff therapist. Within that church leadership role, I lead ministries related to prayer and caring for the soul. My focus is not on catching up with my friends at church. Rather, we set aside intentional times to connect outside of church. I will talk in more detail about this in a later post about self-care for the church therapist.

The American Counseling Association has some helpful information on this topic. Here is a useful link  related to dual relationships: http://ct.counseling.org/2006/12/new-guidelines-on-dual-relationships/

The following article which can be read in its entirety on web.ebscohost.com also offers help on this topic:

Haug, I. E. (1999), Boundaries and the Use and Misuse of Power and Authority: Ethical Complexities for Clergy Psychotherapists. Journal of Counseling & Development, 77: 411–417. doi: 10.1002/j.1556-6676.1999.tb02467.x

*One final note: the article focuses on “clergy psychotherapists” in which the therapist IS the pastor. In my definition of church therapy, the church therapist is on staff for the primary purpose of providing counselor and does not take on pastoral roles with clients. This role definition is useful in the development of clear role expectations.

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Addressing Dual Relationships: Should Pastors Counsel?

In most ethical codes for counselors, there is mention that the counselor should seek to avoid dual relationships that are deemed harmful to the client. There are some areas that are never a good idea (having a sexual relationship with a client) and there are some grey areas (living in a small town and coaching Little League where a client’s child is a participant). Some dual relationships can be prevented, and some are unavoidable especially in smaller communities. Christian communities, even within large cities, can often feel small, with many overlapping circles. Unless you live very far from where you work, even the Christian counselor in private practice is likely to have some unavoidable dual relationships with clients.

Dual relationships, however, are not always harmful. The very first question to be asked with dual relationships is this: does the relationship help or harm the client? In an article published on the website of the American Counseling Association, one of the authors gives an example in which he counsels parents who are raising children with muscular dystrophy. The counselor is knowledgeable in this area because he too has a child with muscular dystrophy. As the counselor serves on agency boards and is active in the community in support of causes related to muscular dystrophy, he frequently interacts outside the counseling arena with his clients. This example is highlighted as a beneficial dual relationship, in which the counselor actually gains MORE credibility with his clients because of his work outside the therapy context.

In 2005 American Counseling Association Code of Ethics was updated to increase clarity about dual relationships and opened the door for beneficial dual relationships to exist. This change was of tremendous help to the Christian community, as counselors available to help church members face this problem daily. Can you see clients from your own church? Can a pastor serve as both a pastor and a counselor? Are these two roles or one?

The Church Therapy model suggests that the professional on-staff counselor is always in the role of counselor. Most larger churches no longer have only one pastor; rather, a team of church leaders work together to handle preaching, teaching, pastoral care/visitation, mercy ministries, and discipleship. Because of the growing awareness of mental health issues within the church, more of these problems are coming to light and are requiring treatment. A church therapist can serve as the person who handles these issues, both with individual therapy and with groups, leaving other pastors freed up to focus on other responsibilities.

Pastors will always meet with parishioners to help them walk through life’s challenges. But when these challenges involve complex emotional issues that will take more than 2-3 meetings to resolve, the church therapist can take over. Because in this model the church therapist is a licensed professional, he or she can properly assess, diagnose, and treat these mental health issues within the context of discipleship and spiritual growth. In this team approach, the pastor can do more of what pastors do very well: admonish, teach, correct, and offer care and support.

When the pastor attempts to counsel in a therapeutic sense in addition to all these other roles, the power differential becomes too great. I have personally seen very complicated situations in which pastors are involved in both counseling and church discipline. In my opinion, the person providing a safe place to talk and work through issues cannot be involved in making church discipline decisions. This dual role undermines therapeutic safety and trust. The Church Therapy model allows for the person undergoing church discipline to continue to see the church therapist, even if he or she has had to be removed from ministries or other areas of the church. In this way, the church continues to offer an option for healing and restoration and the therapist maintains a safe relationship with the client.

Pastors play many roles: shepherd, mentor, coach, leader, guide, teacher, host, and hospital visitor. Adding therapy into that mix often leads to confusion and boundary crossing on the part of both the pastor and the client. Ethical, professional therapy done right will keep the therapy space sacred. Even when the church therapist interacts with the client in other parts of the church building, the therapeutic relationship is kept at the forefront. Confidentiality and clear expectations have been established and are maintained as the top priorities of the church therapist. A pastor simply cannot maintain all of this and do his or her job of leading well.

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Why “Christian Counselors” Need to be Licensed by the State

Sometimes “Christian counseling” gets a bad name. And for good reason. There have been many cases of churches handling issues such as sexual abuse “in house” or pastors committing acts of spiritual abuse. It is important to distinguish what Christian counseling should be in contrast to what it sometimes is. In Christian circles, there are more nuanced terms, including “biblical counseling,” “nouthetic counseling,” and “deliverance” ministries. How can we tell the difference between all these things, especially when we are in need of help?

From the beginning of my writing about Church Therapy, I have always maintained that church therapists (or any other form of Christian counselor) should be licensed at the highest level. I recently obtained my National Board Certification as a Certified Clinical Mental Health Counselor to continue to advocate for Christian counselors to adhere to the highest standards in our society and to demonstrate that Christians can and should provide the best quality care. Because those in the Christian community often do turn to their churches first for help, professionally trained and licensed Christian counselors need to be immediately accessible and available to help.

Having a therapist on a church staff can prevent improper handling of abuse situations because licensed counselors are mandated reporters. (This is legally different for counselors versus pastors in many states.) A licensed counselor is always obligated to report child abuse to authorities, whereas in many states pastors or non-professionals have blurry lines.

A professionally trained and licensed church therapist can also educate the congregation and pastoral staff around issues of mental illness, sexual abuse, and trauma, and in doing so create a culture in which these types of issues are handled with appropriate treatment. Rather than a secretive, “in-house” approach, church therapists are actively connected to the community. I am in regular contact with my clients’ psychiatrists, doctors, and case workers, and when needed local authorities. There is no suspicion of those outside the church, but rather cooperation to make sure every available resource is utilized to protect victims and to care for those in crisis.

Finally, in the Church Therapy model I advocate for use of evidence-based therapeutic practices. We need to be using treatment models that have been proven to work, integrating neuroscientific, biblical, and psychological principles to handle mental health issues in ways that succeed. There is no perfect treatment approach, but we must apply the highest levels of truth and research to inform our treatment rather than making up our own uninformed theories. What untrained, lay counselors in the church produce for treatment models is no more biblical, and certainly no more scientific, than the humanistic theories of Freud. And in fact it does far more damage because it is done in the name of Jesus.

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The Truth About Liability

One of the biggest concerns that pastors and counselors raise about the Church Therapy model is liability. Having a professional practice within the church setting could expose the church to certain risks that would not be present if the church simply refers those with mental health problems out to a nearby practice. When treatment occurs within the church setting, the risk of lawsuit could be higher.

liability

To address this concern, let us first look at some common liabilities for churches. We’ll begin with perhaps one of the biggest liability risks that almost every church has: the youth group. Whether a church employs a youth pastor or has a volunteer staff, a youth group presents a host of legal dangers. Gathering a number of individuals for whom impulse control is difficult and taking them in church vehicles to engage in activities such as swimming, skiing, or boating is a pretty risky endeavor. Yet I have not met a pastor who would discourage all youth outreach and activity for fear of liability risk.

A second liability risk is untrained counseling ministries. Biblical or lay counselors do not carry professional insurance and are not bound by state ethics boards. These ministries pose a much larger legal risk than Church Therapy because counseling is being done outside the bounds of state licensing boards and professional standards. A church paying a pastor to counsel or allowing lay leaders to offer counseling ministries could be sued if a parishioner showed signs of mental illness that were not properly diagnosed or treated and then went on to commit a crime or harm him- or herself.

Click here for a great article outlining these and other legal risks churches face.

The Church Therapy model reduces the risks of legal liability in several ways. First, a Church Therapist is a licensed professional who is upholding ethical standards for practice. Secondly, the Church Therapist can and should carry their own professional insurance of at least $1,000,000 per incident and $3,000,000 aggregate. No other type of church staff member has an ability to carry additional, personal insurance covering their ministry activities. Third, the Church Therapy ministry can be set up as a sole-proprietor private practice or even an LLC. While operating in the church building and on the church staff, the Church Therapist will likely have contracts with insurance companies that will not be in the church’s name. My practice, for example, is legally my own but is housed within the church and operates seamlessly within the church’s daily life.

The larger question that one must ask when thinking about liability is this: what makes the Church Therapy model worth doing? Why not just refer out and avoid the entire issue? Let us again consider the youth group. There are plenty of youth organizations in any given town or city. Why doesn’t the church simply refer the youth who come to the church out to engage in the activities of those agencies? If the YMCA is going on a fieldtrip, why not send the youth with them and avoid a church liability risk? Hopefully the answer is obvious. If the church is to have influence and work in unique ways to heal the hurting and guide the lost, it must run its own programs to do so. Community partnership is wonderful, but liability cannot be the reason we abdicate our God-given role to shepherd and lead. It is central to the Church Therapy model that services provided excellently within the church setting present a more accessible means of treatment that can be done directly in the context of other forms of spiritual growth and discipleship. Referring out to a private practice immediately decreases the rate of follow-up in accessing those services, removes the partnership with the pastor in the counseling process, and disconnects the parishioner’s mental health recovery process from the way the church is already working with that person.

Don’t let fear be a driving force in your thinking as a pastor or counselor. Working with broken people is a risky business, and we must be willing to take on reasonable risk while at the same time maintaining a quality of work that is above reproach.